Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Influence of Gender on the Long-term Outcome of Coronary Artery Bypass Surgery

성별에 따른 관상동맥 우회술의 장기 결과

  • Choi Jong-Bum (Department of Thoracic and Cardiovascular Surgery, Wonkwang University of Medicine) ;
  • Lee Mi-Kyung (Department of Thoracic and Cardiovascular Surgery, Wonkwang University of Medicine) ;
  • Cha Byoung-Ki (Department of Thoracic and Cardiovascular Surgery, Wonkwang University of Medicine) ;
  • Lee Sam-Youn (Department of Thoracic and Cardiovascular Surgery, Wonkwang University of Medicine)
  • 최종범 (원광대학교 의과대학 흉부외과학교실) ;
  • 이미경 (원광대학교 의과대학 흉부외과학교실) ;
  • 차병기 (원광대학교 의과대학 흉부외과학교실) ;
  • 이삼윤 (원광대학교 의과대학 흉부외과학교실)
  • Published : 2006.06.01
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Abstract

Background: Female sex was known to be a risk factor for mortality after coronary bypass grafting (CABG), and women showed higher in-hospital mortality than men. Material and Method: Between 1992 and 1996, 147 consecutive patients (98 men and 49 women) undergoing CABG were included in the study. Most patients had undergone CABG with left internal thoracic artery and saphenous vein under cardiopulmonary bypass. We examined the influence of gender on survival after CABG and looked for risk factors for survival. Result: There was no in-hospital mortality in women, but 3 death (3.0%) in men. During the mean follow-up period of $138.5{\pm}23.0$ months, mortality was lower in women than in men (20.4% vs 44.9%, p=0.004), and the most common cause of death in women was chronic renal failure (40%). Survival in women at 1, 5, 10, and f4 years was 100%, $98.0{\pm}2.0%,\;81.2{\pm}5.6%,\;and\;78.4{\pm}6.1%$, respectively, which was better than in men (p=0.004). Although preoperative left ventricular ejection fraction was higher in women than in men, this did not affect early and long-term survival difference between two sexes (p=0.15). Risk factor for long-term survival in women was diabetes (p=0.033) and in men number of diseased coronary artery (p=0.006). Conclusion: Long-term survival after CABG was better in women than men. Risk factor for long-term survival in women was morbid disease rather than cardiac disease.

배경: 여성은 관상동맥 수술의 위험인자이고 관상동맥 우회술의 사망률도 여성이 남성보다 더 높은 것으로 보고되었었다. 그러나 장기 생존율에 대한 남녀 간 차이는 다양하다. 대상 및 방법: 1992년부터 1996년까지 일차적 관상동맥 우회술을 받은 147명(남 98명, 여 49명)의 환자들을 대상으로 하였다. 대부분의 환자들이 체외순환하에 좌측 속가슴동맥과 하지두렁정맥으로 관상동맥 우회술을 받았다. 성별에 따른 조기 수술결과 및 장기 생존율을 알아보고 성별 위험 인자를 찾아보았다. 결과: 여성군에서 수술 및 병원사망률은 없었으나 남성군에서는 3예(3.0%) 있었다. 평균 $138.5{\pm}23.0$개월의 추적기간 동안 여성에서 사망률이 더 낮았고(여성 10예, 20.4%, 남성 44예, 44.9%) (p=0.004), 여자에서 가장 많은 사망원인은 만성 신부전증(4예, 40%)이었으며 심장사망은 2예(20%)뿐이었다. 수술 후 여성군의 1년, 5년, 10년, 14년의 생존율은 각각 100%, $98.0{\pm}2.0%,\;81.2{\pm}5.6%,\;78.4{\pm}6.1%$로 남성군(각각 $93.9{\pm}2.4%,\;79.6{\pm}4.1%,\;60.2{\pm}5.1%,\;48.6{\pm}6.1%$)보다 매우 우수하였다(p=0.004). 수술 전 여성군의 좌심실 구혈률이 남성보다 더 우수하였으나 여성의 더 우수한 생존율에는 영향을 주지 못했다(p=0.15). 여성군의 장기 생존율에 영향을 주는 인자는 당뇨병(p=0.033)이었고 남성에서는 병변을 가진 혈관수(p=0.006)였다. 결론: 관상동맥 우회술을 받은 여성 환자들에서 장기 생존율은 남성보다 우수하며, 여성의 장기생존에 영향을 주는 인자는 심장질환보다는 동반 이환이었다.

Keywords

References

  1. Yoo KJ, Kang MS, Ko YH, Cho BK, Soh DM. The clinical experience and long-term results with 369 cases of coronary artery bypass graft suegery. Korean J Thorac Cardiovasc Surg 1995;28:583-90
  2. Sergeant P, Blackstone E, Meyns B, Sergeant PT, Blackstone EH, Meyns BP. Validation and interdependence with patientvariables of the influence of procedural variables on early and late survival after CABG K. U. leuven coronary surgery program. Eur J Cardiothorac Surg 1997;12:1-19 https://doi.org/10.1016/S1010-7940(97)00134-6
  3. Myers WO, Blackstone EH, Davis K, Foster ED, Kaiser GC. CASS registry long term surgicd survival. Coronary artery surgery study. J Am Coll Cardiol 1999;33:488-98 https://doi.org/10.1016/S0735-1097(98)00529-4
  4. Choi JB, Lee MK, Jeong ET. Long-term survival after coronary artery bypass surgery. Korean J Thorac Cardiovasc Surg 2005;38: 139-45
  5. Salmon B. Differences between men and women in compliance with risk factor reduction: before and after coronary artery bypass surgery. J Vasc Nurs 2001;19:73-9 https://doi.org/10.1067/mvn.2001.117985
  6. Ott RA, Gutfinger DE, Alimadadian H, et al. Conventional coronary artery bypass grafting: why women take longer to recover. J Cardiovasc Surg 2001;42:311-5
  7. Mickleborough LL, Carson S, Ivanov J. Gender differences in quality of distal vessels: effect on results of coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;126: 950-8 https://doi.org/10.1016/S0022-5223(02)73596-4
  8. Guru V, Fremes SE, Tu JV. Time-related mortality for women after coronary artery bypass graft surgery. a population-based study. J Thorac Cardiovasc Surg 2004;127:1158-65 https://doi.org/10.1016/j.jtcvs.2003.12.008
  9. Toumpoulis IK, Anagnostopculos CE, Balaram SK, et al. Assessment of independent predctors for long-term mortality between women and men after coronary artery bypass grafting: are women different from men? J Thorac Cardiovasc Surg 2006;131:343-51 https://doi.org/10.1016/j.jtcvs.2005.08.056
  10. Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou YB, Pine M. Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 midwestern hospitals. Circulation 2005;112:1323-7 https://doi.org/10.1161/CIRCULATIONAHA.105.564658
  11. Koch CG, Khandwala F, Nussmeier N, Blackstone EH. Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison. J Thorac Cardiovasc Surg 2003;126:2032-43 https://doi.org/10.1016/S0022-5223(03)00950-4
  12. Davis KB, Chaitman B, Ryan T, Bittner V, Kennedy JW. Comparison of is-year survival for men and women after initial medical or surgical treatment for coronary artery disease: a CASS registry study. Coronary Artery Surgery Study. J Am Coll Cardiol 1995;25:1000-9 https://doi.org/10.1016/0735-1097(94)00518-U
  13. Brandrup-Wognsen G, Berggren H, Hartford M, Hjalmarson A, Karlsson T, Herlitz J. Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting. Eur Heart J 1996;17:1426-31 https://doi.org/10.1093/oxfordjournals.eurheartj.a015078
  14. Abramov D, Tamariz MG, Sever JY, et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg 2000;70:800-5 https://doi.org/10.1016/S0003-4975(00)01563-0
  15. Jacobs AK, Kelsey SF, Brooks MM, et al. Better outcome for women compared with men undergoing coronary revascularization: a report from the bypass angioplasty revascularization investigation (BARI). Circulation 1998;98:1279-85 https://doi.org/10.1161/01.CIR.98.13.1279
  16. O'Connor GT, Morton JR, Diehl MJ, et al. The Northern New England Cardiovascular Disease Study Group differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. Circulation 1993;88:2104-10 https://doi.org/10.1161/01.CIR.88.5.2104
  17. Kurlansky PA, Traad EA, Galbut DL, Singer S, Zucker M, Ebra G. Coronary bypass surgery in women: a long-term comparative study of quality of life after bilateral internal mammary artery grafting in men and women. Ann Thorac Surg 2002;74:1517-25 https://doi.org/10.1016/S0003-4975(02)03712-8
  18. Tan ES, van der Meer J, Jan de Kam P, et al. The CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands Worse clinical outcome but similar graft patency in women versus men one year after coronary artery bypass graft surgery owing to an excess of exposed risk factors in women. J Am Coll Cardiol 1999;34:1760-8 https://doi.org/10.1016/S0735-1097(99)00404-0
  19. Brown PP, Mack MJ, Simon AW, et al. Outcomes experience with off-pump coronary artery bypass surgery in women. Ann Thorac Surg 2002;74:2113-9 https://doi.org/10.1016/S0003-4975(02)03988-7
  20. The Korean National Statistical Office. Life table for Korea 2005
  21. Vaccarino V, Lin ZQ, Kasl SV, et al. Gender differences in recovery after coronary artery bypass surgery. J Am Coll Cardiol 2003;41:307-4
  22. Vaccarino V, Koch CG. Long-term benefits of coronary bypass surgery: are the gains for women less than for men?J Thorac Cardiovasc Surg 2003;126:1707-11 https://doi.org/10.1016/j.jtcvs.2003.10.007
  23. Lauer MS, Blackstone EH, Young JB, Topol EJ. Cause of death in clinical research: time for a reassessment? J Am Coll Cardiol 1999;34:618-20 https://doi.org/10.1016/S0735-1097(99)00250-8